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Dementia Flashcards

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1
Q

define dementia

A 
6 months or more of impaired:
memory
cognition
executive function
personality
all in clear consciousness
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2
Q

what cognitive screening tools can be used in dementia and what are their cut of marks?

A

MMSE - 24/30
AMT - 6/10
CAPE test 8/12
clock drawing

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3
Q

what are the different types of dementia?

A

alzheimers
vascular
lewy body
others e.g. CJD, AIDS

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4
Q

what reversible causes must you rule out before diagnosing dementia?

A 
chronic alcohol abuse
vitamin B12 or thiamine deficiency
hypothyroidism
normal pressure hydrocephalus
syphilis
frontal lobe tumour
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5
Q

what cognitive functions are lost in dementia?

A

executive functions e.g problem solving, planning, processing info
visuo-spatial abilties e.g. writing, driving, finding directions
language vocab, understanding language, conversation, finding words

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6
Q

what is apraxia?

A

inability to perform previously learned, purposeful movements despite normal coordination and strength e.g dressing self

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7
Q

what is agnosia?

A

impaired recognition of sensory stimuli not attributed to sensory loss e.g. not recognising faces

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8
Q

what are the non-cognitive symptoms in dementia?

A 
disturbed:
perceptions - hallucinations
thought - delusions
behaviour - wandering, agression, apathy
emotion - depression
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9
Q

how does alzheimers usually present?

A

memory loss - inability to recall new information

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10
Q

what are the pathological features in alzhemiers?

A

global reduction of size of brain
widened sulci
enlarged ventricles
plaque and protein deposition

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11
Q

what are the plaques found in alzheimers made of?

A

beta amyloid

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12
Q

what are the proteins found in alzheimers?

A

tau proteins
form tangled clumps
usually stabilise healthy microtubules in the neuron

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13
Q

in alzheimers, what specific areas of the brain is there neuronal decay?
what are these areas usually involved in?

A

entorhilal cortex in temporal lobe - memory and navigation
hippocampus - memory and navigation
parietal lobe association areas - reading, writing, problem solving

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14
Q

how could you manage alzheimers disease?

A

AchEIs e.g. rivastigmine, galantamine, donepezil
Memantine is used in severe disease or if the above is not tolerated
psychosocial support
antidepressants

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15
Q

what are the ADRs of AchEIs?

A

GI disturbance
increased salivation
drowsiness
worsening of EPS in parkinsons

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16
Q

how is alzheimer’s disease staged?

A

mild
moderate
severe

17
Q

what are the features of mild alzheimers?

A

short term memory deficit

ADL not affected

18
Q

what are the features of moderate alzheimers?

A

significant memory loss
personality and behavioural changes
difficulty in orientation and language
ADL impaired

19
Q

what are the features of severe alzheimers?

A 
dysphasia with disordered speech
agression/restlessness/wandering
psychosis
incontinence
global physical detrioration
20
Q

decribe the pathophysiology of vascular dementia. what could cause vescular dementia?

A

occlusion of blood flow to the brain causes neuronal death

e.g. arteriosclerosis, haemorrhage, embolus, vasculitis

21
Q

what would you check for on examination specifically in vascular dementia?

A

unilateral UMN deficit

focal neurological signs e.g. babinski

22
Q

what are the risk factors for vascular dementia?

A 
hypertension
diabetes
high cholesterol
atherosclerosis
smoking
risk factors for stroke e.g. AF, prosthetic valve, family history, ethnicity
23
Q

what are lewy bodies?

A

abnormal protein aggregates that orm inside nerve cells

24
Q

how does lewy body dementia present?

A

fluctuating levels of cognitive impairment
memory loss
visual hallucinations
parkinsonism
impaired visuospatial skills
the latter two can lead to recurrent falls

25
Q

what investigations would you do in dementia?

A 
FBC
ESR/CRP
U&E
Ca
LFT
glucose
TFT
B12 and thiamine
syphilis, HIV
MRI better than CT
26
Q

what are the areas tested in an MMSE?

A 
orientation
registration
attention
recall
language and copying
27
Q

how do you test for orientation in the MMSE?

A

orientation in time:
year, season, month, date, time (5)
orientation in place:
country, county, city, place, floor/ward (5)

28
Q

how do you test for registration in the MMSE?

A

apple, table, penny

repeat until correct (3)

29
Q

how do you test for attention in the MMSE?

A

serial 7s
or spell WORLD backwards
(5)

30
Q

how to do you test for recall in the MMSE?

A

recall apple table penny

3

31
Q

how do you test for language and copying in the MMSE?

A

ask to name two objects e.g. pen, watch (2)
no ifs, ands, buts (1)
take piece of paper, fold it in half and put it on the floor (3)
close your eyes (read) (1)
write a sentence (1)
copy intersecting pentagons (1)

Psych (5 decks)

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